Medicaid Policy Change and Immediate Postpartum Long-Acting Reversible Contraception

This cohort study assesses the association between a change in Medicaid policy allowing for reimbursement of long-acting, reversible contraception (LARC) separate from the obstetrics global fee and use of LARC immediately postpartum.


Supplement Section 2. State selection
To select states with adequate data quality for analysis we used assessments published by the Centers for Medicare & Medicaid Services DQ Atlas 6 and supplemented our own analyses of the data quality where necessary.We began with all 50 states and the District of Columbia and looked at data quality assessments for TAF RIF Release 2 from 2016, 2017, and 2018 and TAF RIF Release 1 from 2019.
After excluding 22 states that had already implemented an IPP LARC separate billing policy prior to 2016 (Arizona, California, Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Louisiana, Missouri, Montana, New Mexico, New York, Oklahoma, Pennsylvania, South Carolina, South Dakota, Texas, Vermont, Washington) and 4 states and territories with an unclear policy or policy date (Alaska, District of Columbia, Massachusetts, Nevada), 25 states remained for data quality assessment.
Six states classified as unusable or high concern in any of the relevant assessments for any of the measurement years were excluded from our analysis: • 2 states with high concern Total Medicaid and CHIP Enrollment (Maine and Rhode Island).• 2 states with unusable procedure codes on inpatient claims (Kentucky and Maryland).
• 1 state with unusable diagnosis codes on inpatient claims (Tennessee).
• 1 state with unusable procedure codes on professional Other Services claims (Utah).
To assess the remaining 19 states, we conducted two additional assessments of overall TAF data quality.First, we looked at the proportion of enrollment records missing all eligibility information (MISG_ELGBLTY_DATA_IND = 1) and classified states from Low Concern to Unusable based on the same cut-points used in the DQ Atlas assessments of missing gender and missing age on enrollment records (Supplement eTable 2).
Second, we calculated the Claims Volume assessments for our population of interest (Supplement eTable 3 and eTable 4).Because variation in claims volume is not necessarily a sign of poor data quality but may still flag problematic states, we only considered those states classified as unusable on this measure for exclusion.
From these assessments we excluded an additional four states: • 2 states with high concern (> 20%) missing eligibility records (Alabama and Arkansas) • 1 state with unusable Other Services (OT) claims volume in our population (Florida) • 1 state with unusable pharmacy (RX) claims volume in our population (Mississippi) In total we excluded 35 states and the District of Columbia from analysis based on inadequate data quality or IPP LARC policies.Our remaining cohort included 15 states (Colorado, Kansas, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Virginia, West Virginia, Wisconsin, Wyoming).

DQ Assessme nt Assessme nt of OT File Header Record Volume Assessme nt of OT File Line Record Volume Assessme nt of Avg OT Line Records per Header OT File
Supplement eTable 1. Assessment of fully missing eligibility information by state Supplement eTable 3. RX claims volume data quality assessment for eligible women ages 18 to 44 who gave birth in 2016-2019 © 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.© 2024 Rodriguez MI et al.JAMA Health Forum.